Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer
Worley ML, Graboyes EM, Blair J, Momin S, Day TA, Hornig JD, Skoner J, and Huang AT. Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer Head Neck 2019 Apr;41(4):865-870.
Head & neck
BACKGROUND: Following salvage total laryngectomy (STL) with microvascular-free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G-tube) dependence are unknown.
METHODS: Retrospective review of 33 patients who underwent STL with MFTT.
RESULTS: A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow-up. Approximately 27% of patients were G-tube dependent preoperatively with 67% achieving a total oral diet postoperatively. Factors associated with persistent G-tube dependence included pT4 tumor, pN2+ status, more extensive pharyngectomy, and re-irradiation. Strictures occurred in 30% of patients and were associated with more extensive pharyngectomy and tubed reconstruction.
CONCLUSIONS: For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced-stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes.